Concierge medicine has a cost for all patients

When doctors decide to charge additional fees for top-shelf care, many people can't afford it.

I've begun seeing a new patient, a retired delivery driver named Donald. Nice guy, friendly and chatty, and a little mystified as he tries to navigate his way through the constantly changing world of healthcare. He had been my patient many years ago, but we parted ways when I left that office. Donald tracked me down because his former doctor had switched to a concierge-style practice.

Concierge medicine — you may have heard of it — is gaining in popularity. Patients pay a monthly fee directly to the doctor, on top of their regular health insurance premiums and co-pays, to secure better access to the physician. Donald told me that the service was promoted to him as an opportunity to improve the doctor-patient relationship. Instead of juggling more than 2,000 patients, the physician would be able to winnow that number to a very manageable 600, enabling him to devote more time to the select few who opted for premium service.

Being a naturally frugal sort, Donald didn't think such a monetary commitment was prudent, especially on his retiree income.

Even among concierge practices, there are different levels. Some doctors charge very high retainers that give their patients access to them 24/7. Physicians have even been known to vacation with their charges, just in case anything goes wrong.

This raises some interesting logistical problems. What if one millionaire is taking his family to Zermatt, Switzerland, and wants a tag-along doctor while at the same time another client has decided that this is the perfect time of year to see Zanzibar, Tanzania? Oh, the decisions! What does a poor concierge doctor do with such a dilemma?

The same week that I inherited this concierge medicine refugee, two very enticing offers came in the mail. One was from a national concierge chain inviting me out to dinner (yes, they have chains, just like Subway or Target). It was a pretty sweet deal: dinner for me and a guest at a high-end steakhouse in a posh neighborhood, and because my time was so valuable, I would also be paid $300 just to show up and listen to the pitch.

The second offer was even better. Featuring a photo of a beautiful Spanish-style resort with palm trees, a cobalt-blue pool and a lush green golf course, it invited me to attend an all-expenses-paid weekend at Newport Beach to hear from "thought leaders" about joining an elite concierge medicine team.

I'm not a golfer, but I gazed longingly at that picture for quite some time, fighting the urge to pick up the phone and reserve a spot. For a sun-starved Seattleite, any offer of a trip to Southern California is hard to pass up, especially toward the end of an unusually rainy winter.

Yet as tempting as those offers are, I don't see myself as a concierge kind of guy. If I were to join, how many of my patients would lack the resources to join me?

I'd have to leave Ann Marie behind. She has a developmental delay and has been my patient ever since I started in practice. I'd leave the scores of young adults who are just starting out in their careers and find it a stretch to come up with their co-pays. And 7-year-old Tony, who wants me to feel his strong muscles at every visit. Caring for these types of patients can be the most rewarding because they often are the most appreciating of the services I provide.

I am troubled by the growing number of concierge practices, even as I understand that the reason they have gained any momentum at all is because patients are more and more disgruntled about the experience of going to the doctor. Try to get an appointment: Well, that will be a three-week wait and then you've got 10 minutes to plead your case, unless of course you're signed up with "The Plan." Then she can see you right after lunch, and can we get you a nice cuppa tea while you wait?

The doctor won't return your phone calls: Oh, we know how you feel. That's why we offer the platinum service with your doctor's cellphone number on the back of your laminated membership card. Will you be paying with Visa or gold ingots?

I know there are concierge services in other lines of business. At Disneyland, for an added fee, you can be escorted around the park and cut to the front of the line to ride those cute little teacups while the other saps wait and wait. And a friend of mine recently paid extra so that he and his wife wouldn't have to wait three hours to ride to the top of the Empire State Building. He figured it was worth the extra 50 bucks because he was in New York only once and he didn't go there to wait in lines.

I understand his point. But it's a sad statement when businesses say, in so many words, that their service is poor, the waits are long — not to worry, though, have we got a deal for you! Pay extra and we'll give you the four-star service you should have had in the first place.